The internet and social media are not all bad for children. Some online spaces may even help young people to manage their mental health.

The United States’ most senior public health official, surgeon-general Vivek Murthy, believes social media platforms should come with warning labels. The United Nations’ education, science and culture agency says smartphones should be banned in schools. Chinese regulators are pushing to limit children’s smartphone use to just two hours a day.

These are just a few high profile examples of growing global concerns about the risks young people face when using the internet. Those worries are backed by a large, global body of research. Social media use has been linked to feelings of envy, depression and anxiety among young people all over the world, including those in African countries.

This evidence can make for depressing reading, especially if you’re the parent or caregiver of a teenager. Many may be tempted to confiscate their teens’ cellphones, lock away their tablets and keep them as far away from the internet as possible. But that’s neither practical nor helpful in a hyper-connected, digital world.

Though we come from different academic disciplines as a children’s rights researcher, a moral philosopher and a clinical researcher, our current work focuses on the same thing: the ethics of new and emerging technologies and their impact.

We know that protecting children is a shared responsibility. Government, service providers and education systems all have a role to play. But parents are key. So, drawing from our ongoing research, we have three messages for parents trying to navigate this modern minefield.

One, the internet and social media are not all bad for children. Some online spaces may even help young people to manage their mental health.

Two, children and teens have rights to access information, share their views and have those views respected.

Three, by creating a strong foundation of open, loving and trusting communication, you help your children navigate the risks, identify the ethical pitfalls and enjoy the benefits of social media platforms.

Benefits of online spaces

While it is true that internet use comes with risks, there’s also evidence that it can benefit young people.

For instance, interactive features and user-generated content platforms such as social media, blogs and forums enable social interaction and connection. These online spaces allow children to engage with peers, share interests and build communities. They also provide outlets for creativity and self-expression, helping kids to develop digital literacy skills and shape their identities.

Some internet spaces may help children and teens to manage their mental health. The COVID pandemic accelerated the development of digital mental health services like free platforms that connect children to counsellors, chat bots, text tools and apps that offer support for children and parents. Childline South Africa’s free online chat service is one example.

Children’s rights

Too many societies and communities forget that children, like adults, have rights.

In South Africa, for instance, children’s rights are enshrined in section 28 of the constitution.

Globally, the Convention on the Rights of Children (which was adopted by the United Nations General Assembly in 1989) guarantees children’s rights to access information, to freedom of association, to share their thoughts freely and to have their views respected, to health, including mental health, and to privacy, non-discrimination, protection, education and play.

More recently, the United Nations issued guidance on children’s rights in the digital environment.

Several countries (among them Australia, Brazil, Canada, China and the UK now have online safety legislation aimed at protecting kids and teens.

Some parents may wonder why all countries don’t simply make laws to reduce the risks posed by social media platforms. The reality is that it is difficult to implement and enforce these regulations.

African countries have been slow to regulate online safety for minors. South Africa is working on a White Paper that aims to protect children from harmful content and ensure that content meets their needs. However, it is still a draft; new legislation and regulation are years away.

But there is no need for parents to wait before starting to teach their children how to safely use the internet.

Trust and communication

Some parents may fear that they don’t have the skills and knowledge to properly support their teens. Just remember that parents find their way around new things all the time: setting boundaries for young children, teaching them to read and write, and, later on, managing adolescent mood swings, discussing sexuality or counselling teens through their first heartbreaks.

When it comes to safe internet navigation and use, parents and caregivers can help children in two main ways.

The first is by prioritising open, trusting and loving communication from when your children are young. Since children are constantly developing, the kinds of things you discuss will shift over time. You can start talking about the internet and social media when you think your children are ready. This will differ from child to child.

The second is to develop their critical thinking skills so they can analyse and evaluate information and arguments in a clear, rational and objective manner. Parents and caregivers can encourage children to ask questions, challenge assumptions and explore different ways of seeing things. There are also programmes like Web Rangers that help children to develop these skills so they can become responsible digital citizens.

Children who can think critically will gain the confidence to rely on their own reasoning rather than just unthinkingly adopting others’ attitudes. These skills will help them to make responsible choices.

Spending time building a trusting relationship with your children is also crucial. Parenting for a digital future goes beyond the fear-driven response of regulating screen time and parental policing. Critical capacity is developed through negotiation and engagement. And of course these skills are universally applicable, protecting children in other aspects of their lives, too.

Lucy Jamieson, Senior Researcher at the Children’s Institute, University of Cape Town and Heidi Matisonn, Senior Lecturer in Bioethics, Department of Medicine, Faculty of Health Sciences, University of Cape Town

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Globally, around 1 in six people face infertility, that is, the inability to fall pregnant after at least one year of regular unprotected sex. Both men and women can have infertility, but women bear the disproportionate social and physiological burden of not being able to conceive. This is Alucia Mabunda’s story. The campus head at IIE Rosebank College in Nelson Mandela Bay has written a book that delves deep into her own emotional and physical challenges with infertility. This is an abstract from the book titled: The Quest for a Child: A Story of Hardship, Resilience and Faith.  

The routine of each month began to feel all too familiar, with fertomid, ovulation predictor kits, and pregnancy tests becoming staples akin to my regular grocery items. There were times I would test twice or even more within the same day, just on the off chance I might overlook a faint positive result. It was a game of chance also because blood tests are more advisable as some fertility medications can give a false positive on a pee stick. 

Nevertheless, the desire for a child turned the examination of a pregnancy test into a meticulous scrutiny, harbouring the hope that perhaps a very light line might be present. The financial toll of medications, tests, and doctor visits was substantial, with money continuously being drawn from our reserves. Yet, the financial burden seemed inconsequential compared to our longing for a child. 

To ensure we could afford the necessary medical treatments for our fertility journey, both of us were employed in positions that, while not highly lucrative, provided us with the means to prioritise our healthcare needs. I held the position of General Manager at a country lodge located in Venda, Limpopo, and my husband worked as a Life Coach at a high school in Whiteriver, Mpumalanga. 

It’s essential to understand that our financial resources were low; however, we were committed to allocating every available cent towards our fertility treatments. The geographical distance between our workplaces spanned over 350 kilometres through complicated roads, adding a layer of complexity to our lives. Despite these challenges, my husband made the effort to travel to Venda, and occasionally, we found solace in the modest three-roomed house we had built at the village in Tzaneen following our lobola negotiations. 

Amid our financial and geographical challenges, our faith remained unwavering, with Jesus at the center of our hearts. We faced our days with smiles, laughter, and a sense of living fully, even as we carried the internal burden of our unfulfilled desire for a child. However, the physical distance between us became a significant obstacle in our quest for conception. The timing of ovulation is critical, as a woman’s fertile window lasts about five days each month. 

There were instances when the ovulation kit indicated I was ovulating mere hours after my husband’s departure, causing us to miss our opportunity for that cycle. At other times, even when the timing aligned with his return, the toll of his long journey — marked by stress and exhaustion — meant that engaging in sexual activities was sometimes beyond our capacity. 

Navigating the journey towards conception introduces a unique set of challenges, transforming the intimate act of sex from a moment of connection and pleasure into a task with a specific goal in mind. For both partners, this shift can strip away the joy and spontaneity typically associated with lovemaking, turning it into a dutiful endeavour aimed at achieving pregnancy. Compounding the situation, I had to elevate my legs against the wall immediately after intercourse to aid or enhance sperm mobility. Seems a bit funny, considering that other couples conceive without going through all these strategies. 

For someone struggling through what is typically a natural process, receiving advice from those without understanding can be quite painful. Infertility is often misunderstood by outsiders, who might casually suggest to “just enjoy the process” and assure that pregnancy will occur unexpectedly. What is there to enjoy when you are told when to engage, then rush to the elevation of legs? Such advice falls flat for couples deeply engrossed in the pursuit of parenthood, where every intimate moment is inevitably tied to the hope of conception. Despite our fervent prayers and the belief that they were making an impact in the spiritual realm, our physical reality remained unchanged. I hold onto the faith that each prayer planted a seed, awaiting its time to blossom. 

As the year 2013 neared its close, marking nearly two years of our unsuccessful attempts to conceive, we began to face a renewed wave of inquiries and remarks. Questions such as “Don’t you have children yet?” or “You have been married for long, where are your children?” seemed to imply that starting a family was as straightforward as purchasing a loaf of bread from a local store. The most painful question one can pose to a couple facing fertility challenges is about their status on having children. Although some may argue that such questions are born out of genuine concern, I earnestly plead for sensitivity: PLEASE REFRAIN FROM ASKING. Such questions, however well-intentioned, can deeply wound and diminish the already fragile hopes of those struggling to conceive. 

Our journey was not just a battle against infertility, but also against the insensitivity we sometimes faced from those around us. One Friday evening at a funeral, a particularly piercing moment unfolded that I cannot forget. Amongst the gathered relatives, one of the aunts from my husband’s side approached me with a directness that felt like a cold wind. Without a word, she went straight for my stomach, pressing it, her actions laden with silent inquiry. That moment cut deeper than any spoken word could have. It wasn’t just the physical invasion of my personal space that hurt; it was the stark reminder of what I so desperately longed for but did not have. 

This action, perhaps innocuous and driven by curiosity in her perspective, was a glaring example of the lack of sensitivity people can exhibit. She did not say much after touching me, but the message was clear as she went on to greet me. I was bloated, well, that is a side effect of fertility treatments. Unfortunately, being bloated only served to make these interactions more frequent and more painful. You would think people would possess an innate sensitivity towards such a personal struggle, understanding without being told that such actions or questions can be incredibly hurtful. Yet, the opposite seemed true more often than not. 

*Alucia’s book: The Quest for a Child: A Story of Hardship, Resilience and Faith is available on Amazon and Takealot. 
Do you have a story about infertility that you’d like to share? Email us your story at editor@health-e.org.za

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BY Adam Taylor, Lancaster University

From Kylie Jenner and Rihanna to Ariana Grande and Cardi B, celebrities are sporting long, acrylics – often heavily embellished with nail art – as an expression of their style. Nail fashion is now a booming industry with gel manicures and acrylic nails among the most popular current trends. While manicures might feel like self-care, they can ruin healthy natural nails – and might even cause unexpected health problems in a small proportion of people who get them.

For example, the nail glue used to attach acrylics to the natural nail is typically a mixture of alcohol, cyanoacrylate and photo-bonded methacrylate, with other ingredients including formaldehyde, which is a known carcinogen.

The chemicals in the nail adhesives can cause skin irritation and dermatitis.

Nail glue burns are also widely reported. In some cases, nail glue spilled on clothing has caused injury by burning through the fabric and damaging the skin beneath, which can then become infected.

Prolonged wearing of gels and acrylics can also lead to pseudo-psoriatic nails, where extra-skin – known as hyperkeratosis – growing under the nail resembles the red and crusty appearance of psoriasis. Many manicure enthusiasts with pseudo-psoriatic nails test positive for allergy to methyl methacrylate.

In some cases the allergy can be so severe that it causes the permanent loss of fingernails. Others suffer from peripheral neuropathy – tingling or numbness in fingers – sometimes permanently.

An unlikely cause of skin cancer?

There are many factors that contribute to cancer risk, including age, skin type, previous exposure and family history; however, there are cases of skin cancer where UV nail lamp are reported to have played a role.

Gel nails are cured using special dryers that emit ultra-violet light in the form of UVA, which hardens the gel converting it to stiff polymers. Since most people have their nails done every few weeks – and it takes approximately ten minutes to harden – that significantly increases UVA exposure. The back of the hands may be one of the most UV-resistant parts of the body but it’s also unprotected by clothing – and one of the most common places people forget to apply suncream. If sunscreen is applied to hands then it’s often washed off regularly without being reapplied.https://www.youtube.com/embed/WGDe-gLmGiA?wmode=transparent&start=0&autoplay=1

If you’re a fan of gels, reduce your risk of UV exposure by applying a high factor sunscreen 30 mins before the appointment and wear dark, fingerless gloves during the manicure.

Weak, brittle, dry nails

Removal of gels and acrylics often peels or shaves away fragments of the nail plate. Even the most painstaking removal can damage the nail’s keratin layers, which can weaken the nail, cause it to become brittle and the damage can make nails appear white (a condition known as pseudoleukonychia). Many of the chemicals used for removal, including acetone for gel nails, can also dry out the nail and surrounding skin – and be absorbed into the blood stream.

The removal process for both gel and acrylic manicures can wear down natural nails, which can be overfiled, causing stripes running across the ends of the nails, as well as changes and damage to the capillaries underneath.

Removing the nails can also cause traumatic onycholysis, where the nail is pulled away from the bed underneath, giving a classic rollercoaster appearance at the join between the nail and the underlying bed. This can open up the barrier that protects the internal body from the outside world, particularly at the edges on either side of the nail, when they become infected this is known as paronychia.

Leaving false nails on for too long can cause moisture to build up underneath the nail, creating an ideal environment for onychomycosis – the growth of fungus. Often, the changes to the appearance of the natural nail caused by a fungal infection are hidden by the acrylic, so infections can progress without being noticed.https://www.youtube.com/embed/CJmLICeo5Bc?wmode=transparent&start=0&autoplay=1

Bacterial breeding ground

Even traditional nail varnish isn’t without risk. It can alter pulse oximeter readings, which measure how much oxygen your blood is carrying. Thankfully, most of the time these are not altered to a clinically significant level but gels, acrylics and varnish are banned in clinical settings because the spaces under nails and chips on polish are a breeding ground for bacteria which can be passed between staff and patients.

If you enjoy manicures then it might be a better idea to forgo the gels and acrylics and concentrate on caring for your natural nails, leaving them visible so you can notice any changes to their appearance that might indicate health issues, such as fungal infections – and even heart disease.

Adam Taylor, Professor and Director of the Clinical Anatomy Learning Centre, Lancaster University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Montsho Matlala reports – Health-e News: IN SUMMARY

• Water Shortages: St Ritas Hospital in Limpopo has faced ongoing water shortages since 2022 after locals damaged the pipeline in a protest.
• Workers’ Frustration: Hospital staff are threatening to block water trucks, demanding a permanent solution, such as boreholes.
• Inconsistent Water Supply: Nurse Kabelo Mmone says, “I have never finished a week without a water problem.” Workers claim water trucks only arrive after protests.
• Health Risks: Without water, sanitation becomes unbearable, risking diseases. Nurse Jay Sebalo highlights contamination in the water tanks with mud and dead insects found in the water.
• Department Response: The provincial health department says boreholes may not work due to the area’s dryness and states that water quality is regularly tested.
• Hospital Board: Chairperson Sam Malaka admits the hospital relies on water trucks during pipeline issues and has requested a borehole, but no action has been taken yet.
• Temporary Solution: Water trucks are seen as an interim measure, but the need for a permanent fix remains urgent.

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BY Molefi Sompane

Community reactions are mixed, with some criticising the clinic staff for delays, while others urge the public to be patient.

 A Free State man is expected to appear in court this week after he was arrested for assaulting a nurse at Thabong clinic in Welkom. 

The man, who was on parole at the time, went to the clinic in the early hours of the day before the assault, and was not helped as fast as he would have liked. 

“The patient left on his own accord only to return the next day with a bucket full of faeces which he poured on the health worker and causing filth in the reception area,” says Free State health MEC Viceroy Mahlatsi in a statement.

“After the attack, the perpetrator bragged and posted the aftermath of his violent and demeaning attack on Facebook,” Mahlatsi says. 

Attack ‘uncalled for’

Democratic Nursing Organisation of South Africa (DENOSA) and The National Education, Health and Allied Workers’ Union (NEHAWU) in the Free State have joined the health department in lambasting the attack. 

DENOSA Free State chairperson, Talbort Thole, says the actions are uncalled for.

“We are calling for the department to provide our nurses with security. We call on our members to exercise professionalism at all times and not engage in fights. We therefore would like to plead with the public not to assault nurses regardless of what may have happened,” says Thole.

NEHAWU secretary Konstable Selebedi also weighs in.

“It is uncalled for to assault a worker and we are calling for employer’s support for the employee.”

The police apprehended the suspect after the health worker filed a case. The MEC’s office provided her with counselling soon after the incident. 

Mixed reactions 

Masabata Monyobo is a member of the community in Thabong. She says nurses are ignoring patients’ psychological problems. 

“What happened is not right and it should’ve been stopped but our nurses are taking patients for a ride. How can you fail to help a patient who came to the clinic two consecutive days?” she asks.

Member of the clinic committee which helps to control the queues and ensure effective services, Disebo Monaheng called on the public to work with nurses.  “I want to appeal to our public to help us by being patient when they are at the health facilities. They need to understand that it takes time to help a single patient. We were at the clinic and we saw what happened, the guy was not talking well with the nurses he demanded to be helped and he was swearing at the nurses,” she says. – Health-e News 

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Yvette Raphael believes everyone should have access to the full package of protection against STIs, and unwanted pregnancy.

This article is part of an African Alliance series celebrating 25 years of the inner condom in South Africa and the people who helped to establish the world’s biggest state-funded inner condom project.  

Activist Yvette Raphael first heard about the inner condom in the early 2000s. It was shortly after she was diagnosed with HIV, when she became a human rights activist who fights for young women and lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) communities.

Back then, hundreds of thousands of South Africans were dying of AIDS each year. Raphael and her fellow activists were tasked with raising awareness about the inner condom, which held the promise of choice for women whose partners weren’t keen on using protection.  

Two decades later, Raphael is the co-founder and co-director of Advocacy for Prevention of HIV and AIDS (APHA) in South Africa, she speaks to African Alliance about those early days of activism with the spirit and verve for which she’s become known.

South Africa now has the biggest government-funded inner condom programme in the world. Two decades ago though, Raphael and her fellow activists were fighting waves of misinformation about these condoms. She thinks disinformation about the inner condoms was probably just as well established as the myths about antiretroviral medicines. 

There was the drama and negative sensationalism  that inner condoms were too big, for instance.    

“I remember going into a training session and this facilitator was just explaining how big it is, and how it’s going to cover over the front part of the vagina, and how you have to make a perfect eight [with insertion, for it to work]. All of those things just turned women off of it.”

The inner condom does not have to be made into a complicated eight shape to work. In reality, it’s similar to using a tampon, except you squeeze the closed end with fingers to insert, then use a finger to push it as far as it will go, up to the cervix. As long as you make sure the outer, open ring is still on the outside, you are good to go.

Raphael says other challenges were the availability of the inner condom, the costly price to manufacture it, and the fact that people get 10 male condoms in a strip, but would only be handed one or two female condoms per person. 

Getting in the driver’s seat of your sexual health

 “First of all, the inner condom is important because it’s one of the early female controlled interventions. I think we did not emphasise the fact that this is agency, this is female control.”

She adds that as one of the HIV prevention methods, it’s important for everyone to remember it’s another option in the basket for people with vaginas – and we shouldn’t throw it out.

“Women are not homogeneous. Every single woman has different needs and there are women who would prefer to have sex with an inner condom – they need to have it accessible.”

She points out that people may go through phases; today they may prefer to use an inner condom, tomorrow they might reach for an  HIV prevention medicine such as PrEP (although using PrEP without a condom won’t stop people from getting other sexually transmitted infections). 

But it’s women’s right to choose, she says.

“We should not get tired [of emphasising the fact] that it is a choice. We want women to have options available so that women can make choices.”

On September 8, 2023, The African Women’s HIV Prevention Community Accountability Board launched its HIV Prevention Choice Manifesto in Kampala, Uganda. The Choice Manifesto calls for continued political and financial support for more choice in HIV prevention to meet the needs of girls and women in Africa, and allow them to shape their own futures, with a seat at the table.

Keep calm and condom on

What does she want for the future of the inner condom?

“Wherever there are male condoms, there should be the same number of inner condoms.

 “People need education around the inner condom and how to use it,” Raphael adds. 

She believes that a transfer of knowledge has to happen; from the seasoned advocates to the younger generation – a passing on of the baton, to take the fight forward.

It’s silly, Raphael says, that everybody gets taught how to use a male condom in school, when not everybody has a penis.

The government’s sex education curriculum does include lessons on both types of condoms, but it’s unclear to what extent teachers are following these plans. The plans caused a huge outcry from parents and teachers unions when they launched in 2019. 

Raphael says information about inner condoms should be unavoidable. Instructional pictures should be everywhere; on clinic walls, at informal gatherings, and in community meetings. 

Passing the baton 

Raphael has worked on award winning programmes, including Brothers for Life, Scrutinize, Four Play, Intersexions and ZAZI.

In the ZAZI training programme she worked to include information about new prevention technologies and to mentor young prevention advocates. The ZAZI toolkit is being revived, she says, and they are using the HIV prevention methods so young people can be informed.

“If you go into these meetings and watch, you realise that there’s truly a gap of information for young people who are in this space. Then you ask yourself, how many of these young people are able to do a session and transfer knowledge and also be champions for HIV prevention? So, for me that is a big gap is that we do not have enough HIV prevention champions walking around the country.”

Stigma around HIV and STIs remains an ever-present issue, with people not wanting to get tested. Raphael explains that while funding for HIV may be being cut down, there’s certain programmes we know work and should be kept – things like peer educators and making the full kit of HIV prevention available for the public. 

Raphael says she’ll continue to advocate for the full package of HIV prevention and treatment, including inner condoms, but she thinks it’s time for a new generation to speak up as well. 

“It’s high time younger people with the same amount of grit picked up the baton, to help carry the load.”

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A post,

The Malnutrition Crisis: Prioritizing the Health and Well-being of Future Generations, first appeared on Health-E News.

By Health-E News

As the dust settles on the recent elections, it is time for the new administration to confront a silent catastrophe that has plagued our nation for far too long – the malnutrition crisis. The haunting statistics reveal a grim reality: over 1.5 million children in South Africa suffer from stunted growth, a reflection of the chronic lack of proper nutrition and care during their crucial early years.

Haunted by the Ghost of 1.5 Million Tintswalos that will never be

These children, robbed of their full potential, face a future marred by academic struggles, unemployment, and chronic illnesses. The staggering numbers paint a bleak picture of missed opportunities and unfulfilled dreams. The State of the Nation Address may have come and gone, but the ghost of 1.5 million lost Tintswalos continues to linger, a stark reminder of the urgent action needed to address this pressing issue. In the face of the escalating malnutrition crisis, we implore the incoming administration to place policy interventions at the forefront of their agenda. The implementation of comprehensive nutrition programs, the promotion of education and awareness campaigns, the enhancement of healthcare access, and the fostering of collaborative partnerships are all critical strides towards paving a brighter future for our children.

The maternal support grant (MSG) represents a policy intervention with profound implications for our children. By placing nutrition at the heart of their priorities, the new administration will essentially be investing in the health of future generations.

This grant is also in alignment with the United Nations Sustainable Development Goals, which underscores the importance of good health and well-being for all. However, it’s important to note that the MSG is not merely financial assistance but an investment in our collective future. When mothers are equipped with the necessary resources, they are empowered to nourish their families effectively. As we champion for more robust policies, it is crucial to acknowledge the transformative power of this grant in mitigating malnutrition and fostering healthier, more prosperous communities.

Children who are too short for their age are likely to reach less than half of their full potential, if they are lucky. More often than not, they will face academic hurdles, as the chronic lack of healthy food during the early years of their lives means their brains and other organs didn’t receive the nutrients needed to develop properly.

Consequently, many of these stunted children will inevitably drop out of school, condemning them to a future plagued by unemployment. Additionally, being too short for their age also predisposes them to chronic illnesses such as diabetes and hypertension, exacerbating their struggles as they navigate an already overburdened healthcare system, further dimming their prospects for a brighter future.

Tintswalo: An endangered species

The president’s portrayal of Tintswalo as the norm does a disservice to the reality facing many young children in South Africa. While Tintswalo represents untapped potential within our nation, the sad truth is that achieving Tintswalo-like success is often a matter of chance in our country. Success here is still too closely tied to factors like family wealth, race, neighbourhood, and access to the right people. For many ambitious children, the odds are stacked against them from the start.

Unfortunately, many potential Tintswalos do not even make it past the age of five due to malnutrition. This is a tragedy in a country that is not food insecure but rather a significant food waster, with millions of tonnes going to waste each year. Urgent action is needed before Tintswalo becomes an endangered species, at risk of hunger and malnutrition in a land abundant with resources.

Every day, we lose 30 potential Tintswalos to hunger-related causes in South Africa, totalling 10,000 young lives annually. This includes 1,000 children who directly perish from severe acute malnutrition and approximately 9,000 more under the age of five whose deaths are influenced by malnutrition. These heartbreaking statistics underscore the critical importance of prioritising nutrition as a foundational element in our quest to build a brighter future for all.

Children Left Behind as Poverty Line and Child Support Grant Fail to Align

The fact that malnutrition remains a leading cause of death among young children in South Africa is a sobering reminder of the work that still needs to be done to protect our most vulnerable citizens. Every child deserves a fair chance at a healthy and fulfilling life, and it is our collective responsibility to ensure that they receive the support they need to thrive. Section 28(1)(c) of the Constitution gives every child the
right to basic nutrition which is critical to ensuring they get a fair chance in life.

However, in South Africa, we are still far from levelling the playing field for every child. In a country where the food poverty line hovers at R760 per person per month, the stark reality of malnutrition and poverty intertwines to form a harrowing narrative.

This figure represents the bare minimum required for an individual to meet their daily basic food needs, yet it remains out of reach for the majority of young children in South Africa. Obviously, at R530 the child support grant falls short of this threshold, underscoring the systemic challenges faced by families struggling to provide adequate nutrition for their children. Addressing malnutrition is not just a moral imperative but a strategic necessity for achieving our collective aspirations.

While Sustainable Development Goal (SDG) no 2 explicitly addresses nutrition, its significance transcends this singular goal, permeating the fabric of all 17 Sustainable Development Goals. Nutrition serves as a linchpin in the pursuit of a sustainable and equitable world, underpinning key aspects of health, education, economic prosperity, and environmental sustainability. As we navigate the complex landscape of global
development, it becomes increasingly clear that addressing malnutrition is not just a moral imperative but a strategic necessity for achieving our collective aspirations.

Priorities for the New Administration Post-Elections in South Africa: Elevating Children’s Nutrition

Following the recent elections in South Africa, it is crucial for the new administration to prioritise the well-being and future success of our nation’s children. A study published in The Lancet in 2008 emphasised the long-term impact of good nutrition in early life on the future success of individuals. This underscores the importance of ensuring that every child, starting from their time in the womb, receives the
necessary nutrition for healthy growth and development.

As citizens consider the parties they will support, it is essential to choose leaders who prioritise providing nutritious food to children right from the beginning. Ensuring that social grants align with the food poverty line is a critical step in enabling families to afford adequate nutrition, ultimately reducing hunger and enhancing the overall health of our children.

Early identification and intervention are key strategies in addressing malnutrition effectively. A party that implements efficient systems to identify children at risk of malnutrition and takes prompt action can prevent long-term health issues and improve children’s chances of thriving. Access to basic nutritious food should be a fundamental priority for the new administration. Identifying essential foods and ensuring their affordability is crucial in the fight against hunger. A party that focuses on making healthy food accessible to all families will contribute to building a healthier and stronger community.

A well-nourished nation is a happy and successful one, while a hungry nation faces challenges and unrest. By electing leaders who prioritise providing nutritious food to our children, we can work towards a brighter future for all. This fundamental need must be addressed collaboratively with our leaders to create a thriving and prosperous nation.

The upcoming period post-elections presents a unique opportunity for leaders to focus on the well-being of our young children. By emphasising early childhood development, ensuring access to nutritious food, and implementing sustainable solutions, we can establish a legacy of care and opportunity for all South African children. It is time to advocate for change, support the potential of every child like Tintswalo, and build a future where every child can thrive and succeed. –Health-e News

As the dust settles on the recent elections, it is time for the new administration to confront a silent catastrophe that has plagued our nation for far too long – the malnutrition crisis.

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54 000 TB deaths driven by inequality, first appeared on Health-E News.

By Yoliswa Sobuwa

148 people die of tuberculosis (TB) daily in South Africa. According to the  South African TB survey, South Africa is one of thirty high burden TB countries that contribute to 87% of estimated incident cases worldwide.

Speaking at the opening of the 8th SA TB Conference in Durban yesterday, Health Deputy Minister, Dr Sibongiseni Dhlomo said poverty, inequality and undernutrition remain the primary drivers of South Africa’s TB epidemic.

The solution, he says, is a multifaceted approach that includes improved diagnostic tools, better healthcare worker training, enhanced patient tracking systems, stigma reduction and lowering of financial barriers associated with treatment.

“One major issue is the inadequate testing for people living with TB, which hampers early diagnosis and treatment. This problem is mostly common in children, where case finding is limited due to health worker uncertainty and the difficulty of obtaining samples from young patients,” he says. 

Another critical challenge is a high loss to follow-up, (patients who are unreachable) caused by healthcare access barriers, lack of transport for patients and limited tracking capabilities. 

“These issues prevent many patients from completing their treatment, which is crucial for both their health and the broader public health effort. Low treatment adherence remains a significant obstacle, influenced by stigma, catastrophic costs, clinic congestion, misunderstanding of TB, conflicting health beliefs, and substance use,” says Dhlomo.

Solutions to South Africa’s TB burden

Steve Letsike, South African National Aids Council (SANAC) deputy chairperson says TB is a social challenge that cannot be defeated through biomedical interventions only. 

Letsike says much like HIV, TB requires a multisectoral and community centred approach. “We need to change our TB management approach to be more holistic by engaging multi-sectoral stakeholders at every stage of the elimination process in order to make positive change. We also need to bring the lab closer to patients and enable a test and treat approach in one visit,” she says. 

She stresses that the TB conversation must be kept alive.

“We cannot be bystanders when people are dying of TB, we must be clear on our position regarding our response to the disease. We need to have a plan on how to address disparities that still exist in the TB programme,” she says. 

Dhlomo says the department is prioritising high burden populations and regions to ensure that resources are directed where they are most needed. 

The national TB survey revealed high prevalence among men, young adults aged 15-24 years and HIV positive individuals.

Dhlomo says improved TB social and  behavioural change communication is crucial for enhancing TB programming. 
“We have crafted user-friendly TB dashboards accessible to TB program managers at every level of the health system,” he says. –Health-e News

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Budget Cuts Force Closure of Shelters for Abused Women in Gauteng, first appeared on Health-E News

By Yoliswa Sobuwa

On April 23, a 23-year-old pregnant woman, days away from her due date, was forced to leave a shelter provided by People Opposing Women Abuse (POWA) as the organisation shut its doors due to budget cuts. This closure is a direct consequence of the Gauteng Department of Social Development (GDSD) slashing its budget.

This is the second year GDSD has run short of funding for the 767 non-profit organisations (NPOs) in Gauteng it supports. In mid-May, Premier Panyaza Lesufi said the 2024/25 budget, which was cut to R1.8-billion, will be increased to R2.4-billion. At least 100 NPOs across the province are affected.

Thoko Budaza, the executive director of POWA, expressed deep concern over the impact of these budget cuts. “The young woman had no place to go. She was raped, and her family sided with the rapist. It was heartbreaking to see her leave just before her due date. She was the last person to leave our shelter, and we had no resources to help her. We’ve had to retrench staff and cut salaries because of the lack of funding,” says Budaza.

POWA operates two shelters that can accommodate about 157 women and their children. The organization also serves around 17,000 beneficiaries through its gender-based violence prevention and awareness programs. 

“Our shelters are empty, and abused women and children have nowhere to go. Some staff members are now forced to walk to work because they haven’t been paid. We can’t even afford utilities, and we may have to close our offices soon,” Budaza says. 

David Barrows, from Mahalia Feeding Scheme (MFS) NPO in Eldorado Park, Soweto, shares similar frustrations. “We’ve been operating for 11 years, providing for 200 children, most of whom are orphans or come from homes with drug or alcohol abuse. These past months, we’ve relied on community donations for food,” he said.

Epworth Children’s Home, which has served children and families for 105 years, announced its closure effective May 31 due to the funding shortfall. Director Penny Lundie explains, “We’ve had to retrench staff and relocate children. We were assisted by a donor, but without the provincial support, we can’t continue. We hope that promised payments will allow us to stop retrenchments and bring the children back.”

The Gauteng Care Crisis Committee (GCCC) took the provincial social department to court demanding payment of funds and subsidies to the NPOs. The Gauteng High Court in Johannesburg handed down an order on 22 May compelling the province to conclude the adjudication of applications submitted by Social Work Organisations (‘SWOs’) for funding in terms of the advertisement issued by the respondent on 01 November 2023 and accordingly inform all SWOs who applied for funding as to the outcome of their applications for funding, by 24 May 2024.

Judge Ingrid Opperman ruled that the department should conclude its funding adjudications by 24 May for all social work organisations that had submitted applications. The department has to issue service level agreements to all successful organisations by 30 May and pay all monies due to organisations within seven days of the service level agreements (SLA) being signed. The department also has to provide a report by 7 June with a list of all organisations that have been approved for funding. 

Lisa Vetten, chairperson of the GCCC told Health-e News the department missed its payment deadline but issued interim service level agreements (SLA) over the weekend. “It’s concerning that residential facilities are not prioritised. They are running out of food and can’t afford utilities. Only three NPOs have been paid so far,” she said. 

Budaza confirmed she received an SLA. 

Gauteng social development spokesperson Themba Gadebe says that payments are in progress. “Some organisations have already been paid,” he told Health-e News.-Health-e News

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Gauteng: 38,000 on Surgery Waiting List, first appeared on Health-E News

By Yoliswa Sobuwa

In March, the Gauteng Department of Health triumphantly declared it had cleared a surgical backlog of 37 000 cases. Last week,  Gauteng Health MEC Nomantu Nkomo-Ralehoko admitted there remains a waiting list of 38 000 surgeries, in response to legislature questions by the DA’s MEC for Health, Jack Bloom. He criticized the provincial government for ‘failing to run a decent health service’ despite a R64.8 billion budget, warning of the potential disaster of implementing the NHI.

A shortage of high-care beds, limited theater time, increased trauma cases, infrastructure problems, and water and power cuts are among the issues contributing to the surgical backlog in Gauteng.

In July 2023, the department launched a campaign to conduct surgical marathons to clear the backlog. In a statement last week it said:

It is important to highlight that while the historic surgical backlog has been eliminated, there is a distinction between the backlog list and the waiting lists, comprising of new cases, which is being managed on an ongoing basis as a priority for the department.

As of end of April 2024, there were 38,000 patients on the waiting list which is a dynamic entity that is managed daily. The Department remain committed to ensuring timely access to surgical care for all patients in need. Already 14,000 patients have undergone their scheduled surgeries since the beginning of May 2024 to date. This reduces the number of patients on the normal surgical waiting list to 24 000.

Multi-sectoral issues

Dr. Tshilidzi Sadiki, Deputy President of the South African Medical Association Trade Union (SAMATU) and a neurosurgeon at Dr. George Mukhari Academic Hospital, highlights multi-sectoral issues leading to ever-increasing waiting lists in public hospitals. He told Health-e News trauma operations, due to violence and road incidents, often take precedence over elective operations, contributing significantly to the backlog.

“The burden of disease has increased compared to the past, and hospitals were initially intended to handle different volumes and types of cases. Trauma injuries from violence and road incidents have become a pandemic for theaters,” says Sadiki. Hospitals prioritise trauma cases over elective ones, and the lack of ICU beds further exacerbates the problem. 

“To run a surgical procedure is not like walking into a theatre and operating. There are things to be considered, like post operative care. However the ICU beds are not readily available due to increased disease burden,” he says. 

Late presentation of patients and transportation issues also contribute to the backlog.

“Even when they (patients) are given a date to come back to the hospital, they are unable to transport themselves to the healthcare facility. At times hospitals are battling with new consumables (theatre equipment) not readily available due to limitation of stock or budget issues,” he says. 

He says another problem is that patients sometimes seek tertiary hospital services that could be provided by district and regional hospitals. The population served by major hospitals like Chris Hani Baragwanath and Dr. George Mukhari Academic Hospitals has grown tremendously, with over five million patients visiting public health facilities in Gauteng annually.

In a reply to Bloom’s questions, Health MEC Nomantu Nkomo-Ralehoko cited patients lost to follow-up and a shortage of ICU capacity for complex cases as reasons for the backlog. Infrastructure challenges, such as extreme theater temperature changes, and consumable shortages due to non-payment to suppliers, further extend waiting times. 

“In some hospitals like Helen Joseph there is an increased number of patients awaiting surgeries because of infrastructure problems and limited theatre time. At Rahima Moosa Mother and Child Hospital water shortages cause cancellation of cases and increases in waiting times,” she said. 

Waiting Lists

Steve Biko Hospital has the largest waiting list of 7366 patients

Chris Hani Baragwanath Hospital – 4958 patients

George Mukhari Hospital- 4627 patients

Charlotte Maxeke Johannesburg Hospital – 3777 patients

Tshwane District Hospital – 2531 patients

Kalafong Hospital  – 1982 patients

Tembisa Hospital – 1950 patients

Helen Joseph Hospital – 1657 patients

Mamelodi Hospital – 1565 patients

Sebokeng Hospital – 1402 patients

-Health-e News

In March, the Gauteng Department of Health triumphantly declared it had cleared a surgical backlog of 37 000 cases. Last week,  Gauteng Health MEC Nomantu Nkomo-Ralehoko admitted there remains a waiting list of 38 000 surgeries, in response to legislature questions by the DA’s MEC for Health, Jack Bloom. He criticized the provincial government for […]

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Dr Chat GPT: Can AI improve healthcare in Africa?, first appeared on Health-E News.

By Health-E News

When Salma Said experienced persistent fatigue and weight loss in her village in Morogoro, Tanzania, she hesitated to seek help, fearing the cost and time required to get care. Her livelihood dwindled as she became unable to work. I only met Salma on admission to the hospital, confused and unable to walk. Her diagnosis was a stroke that was secondary to Type Two diabetes, a condition that can be simple to manage and prevent.  

Africa currently has the world’s highest mortality rates due to undiagnosed diabetes, reports the World Health Organisation (WHO). The stark fact is that if Salma had had better access to healthcare advice, much of her suffering – both physical and mental – could have been avoided.  

As a doctor working in Africa, it was the plight of Salma and countless other patients like her that drove me to team up with like-minded professionals to take action. The state of healthcare on our continent is complex and multi-layered, with inefficiency, poor administration and low government spend being major contributors to poor healthcare outcomes. It is estimated that less than half of the continent’s people have access to the care they need.

Tech driven solutions

Our solution has been to harness the power of technology to ensure that more people can get the medical help they need, efficiently and cost effectively via a simple app they can download onto their phones. As soon as they have registered, users can chat with a doctor, get a referral, lab investigation order, or even a prescription. The services cost around $3 per session, which is about half of what it costs at private hospitals. 

And we are far from alone. Across the continent, healthtech is on the rise. Boosted in part by the COVID-19 pandemic, increased internet penetration, and cellphone use, innovators are stepping up to transform health product distribution, with new models serving consumers directly, easing product supply, and offering product data services. For example, Dawa Mkononi, which was launched in Tanzania in 2022 after founder and CEO Joseph Paul realised a poor distribution of pharmaceutical supplies to the growing Tanzanian population, leverages technology to manage inventories, orders, and timely delivery to more than 300 pharmacies, and is looking at expanding the service to other regions in Africa. Hello Doctor in South Africa and ChanjoPlus and M-Tiba in Kenya, as well as GoMedical in Benin and mTrac in Uganda all fulfil a somewhat similar niche. 

As technology advances, so too can these solutions. While many have voiced concerns about the role of rapidly advancing technology – most notably generative AI – in shaping the future of humanity for the better, there is increasing evidence that it can play a vital role in the healthcare sector. Research presented at the American Diabetes Association conference in San Diego in June 2023 showed how telemedicine could help save lives for patients with diabetes, improving not only diabetes care but also decreased the financial burden caused by these complications, which include serious medical conditions like strokes, heart attack, ulcers and amputations. In another example, researchers in the US developed a new AI model capable of evaluating electrocardiogram (ECG) results and identifying signs of occlusion myocardial infarction faster than other modern techniques.   

Of course, this is not to say that technology is an unalloyed good. There are many issues including the privacy concerns that come from gathering sensitive personal data on people that must be properly addressed and understood if we want to ensure that the technology contributes to driving health equity.   

No silver bullet

It is also important to acknowledge that technology on its own is not a silver bullet. As Katusha de Villiers and Gillian Moodley from the Bertha Centre for Social Innovation and Entrepreneurship based at the UCT Graduate School of Business point out, while ingenious solutions are making a huge impact, on their own they won’t be enough to build a more equitable health system in Africa.  

To build an inclusive health system the continent needs to address structural inequalities – political, social and economic – and this will require that private and public partners alike embrace radical collaboration to support inclusive innovation. “Health equity is everyone’s business,” they write. “Every actor in the ecosystem needs to do what they can to support the innovation and resilience of social entrepreneurs and innovators at ground level and they need to work together to go further.”

 There is also much that we need to do to dismantle the barriers to innovation in healthcare from addressing regulatory complexities and changing organizational cultures to aligning stakeholder interests to unleash more innovation in the sector.  

But such change takes time. And while serious interventions and systems change need to happen to drive healthcare improvements across the continent, many Africans can’t wait for the change. People are sick and dying now; they need help. The great advantage of technology-driven innovation and AI is that it is able to offer us ground-breaking solutions to a crisis – right now – building a healthcare system that puts the patient at the centre as we seek to build a better system overall.

New healthcare apps powered by AI are being launched across Africa, helping to provide fast, affordable, and user-friendly medical advice and lifesaving treatment to thousands of people who may otherwise have not had access to it.

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The conference was held from 6 to 8 May 2024 at the University of Free State with a promise to tackle the pervasive issue of insecure land rights that plagues rural communities in Africa. The papers presented cut across many disciplines and themes from property, environmental law, conservation, customary law and succession, gender and traditional practices, socio-economic rights to agriculture and land reform, as well as governance.

PLAAS PhD candidate Shane Phiri presented a comparative analysis of beneficiaries’ tenure security. His work challenges conventional models of tenure security and underscores subjective perceptions and related power dynamics that make it up. This builds on long-standing work at PLAAS on the outcomes of land reform: state neglect and elite capture, and the constitutional principle of equitable access to land.

Tenure security refers to the legal and social protection of land and property rights. It is a crucial aspect of sustainable development, as it provides individuals and communities with the confidence and stability they need to invest in their homes and livelihoods

Why tenure security matters
Tenure security is essential for a variety of reasons. First, it provides individuals and communities with a sense of ownership and control over their land and property. This could potentially encourage investment in improvements and maintenance, leading to increased productivity, stability and economic growth. The dominant approach to tenure security promotes privatisation and formalisation. This pegged on the assumption that formalised rights are more secured and superior to informal (off register) and customary rights. Throughout the conference the merits and pitfalls of such assumptions were debated and challenged.

Despite its importance, tenure security remains elusive for many people living on the continent. Across different contexts, delegates expressed the following as the challenges to achieving tenure security:

Weak legal frameworks: many African countries lack clear and enforceable laws that protect the land rights of rural communities
Corruption and weak governance undermine efforts to improve tenure security by allowing powerful individuals or groups to seize land or property from vulnerable communities.
The survival of the bifurcated state, which perpetuates dual system of authority in Africa, and insecurity for rural communities
Legal plurality – which substantively undermines and prevents women and marginal groups from accessing, using and inheriting land.
Lack of awareness and education: Many people are unaware of their land and property rights or lack the education and resources to defend them.
Lack of clarification on what constitutes an eviction. This is a pertinent issue with regards to farm dwellers rights to own and graze livestock/ cattle
Conflicting land uses for example, artisanal mining on residential land in Zimbabwe
The costs of litigation, and the law used as baton against disempowered communities
The interweaving of conservation efforts to protect and preserve nature with capitalist interests leading to new forms of enclosures and dispossession

Various Strategies for Improving Tenure Security:

Strengthening legal frameworks: the development of legal systems geared towards eliminating structural inequality
Addressing corruption and improving governance: governments can also address corruption and improve governance by increasing transparency and accountability in land administration.
The promotion of prior informed consent of rural land communities in land decision making, in particular where the land holding structure is being controlled by traditional authorities or state regulatory structures. Succinctly summed up with the quote “nothing about us without us”
Dismantling apartheid’s spatial planning in order to promote more inclusive and secured land rights
Recognising informal rights as inherently legitimate and equated to formalised rights. This is intended to circumvent dispossession of rural communities.
Introducing “land counselling initiatives” in Nigerian schools to increase awareness and education about land and the contents of people’s property rights

Conclusion
The conference created a space to actively engage with broader elements involved in securing access and claims to the land. This called to attention the multiplicity of norms, rights and institutions that shape the struggle for tenure security. Drawing from the presentations, situations of normative and institutional pluralism are prevalent throughout the continent. There are myriad relations, intuitions and social rules that underpin security. These embedded relations are tethered to the material and subjective realities existing in each context. Legalistic approaches to tenure security fail to capture these complexities. Formalisation does not create a haven for tenure security.

On the one hand, constraining tenure security under the guise of formalisation is seen reproducing social inequality and making tenure security an ongoing site of struggle. On the other hand, formalised rights are ripe for appropriation and dispossession, leading to more insecurity. The path towards tenure security lies at the cusp of political, social and legal powers that shape land relations.

Tenure security should be recognised as multidimensional, and reflective of norms, perceptions and practices existing on the ground.

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Upholding public health over tobacco industry interference: is government doing enough? , first appeared on Health-E News.

By Health-E News

Imagine a world where the air we breathe in public spaces isn’t tainted by a deadly substance and where people are free from all forms of nicotine. Imagine laws so robust that the marketing tactics of tobacco and electronic cigarette companies couldn’t hook our youth on a lifetime of addiction. Sadly, this is not yet the reality – not in South Africa, nor in numerous countries where the battle against smoking and its modern iterations rages. The pressing question is this: in our pursuit of public health, is the government doing enough to protect our right to clean air and knowledge of threats to our health, or are we faltering in the face of the tobacco industry’s might?

In the ongoing battle between public health imperatives and industry interests, South Africa finds itself at a critical juncture with the pending Tobacco Products and Electronic Delivery Systems Control Bill. The legislation, aimed at enhancing public health measures, seeks to introduce stricter regulations on tobacco use, including limitations on smoking in public places, stronger rules on packaging, and restrictions on tobacco point-of-sale advertising. However, it faces significant pushback from the tobacco industry.

Finally approved to go to Cabinet in 2022, the comprehensive Tobacco Control Bill still awaits Parliament’s final approval, but has stalled at the public consultation process. Public consultations were carried out in seven of the nine provinces by the parliamentary portfolio committee on health. Two provinces were yet to complete this crucial step in the parliamentary process – KwaZulu Natal and the Northern Cape – but these have been postponed since January 2024. As they were not concluded before the elections, the future of the Bill will be left up to the next administration’s discretion.

Industry interference

In an environment where there is strong tobacco industry interference, we must question why. Delays in the passage of the Tobacco Control Bill only favour the tobacco industry, not the public health of South Africa. The 2023 Tobacco Industry Interference Index Report highlights a concerning rise in tobacco industry influence on South African policy-making, noting an increase in tobacco companies targeting non-health government sectors, sponsoring organisations close to the government, and having unnecessary interactions with officials. The report calls for urgent government action against the tobacco industry’s tactics that hinder tobacco control efforts. Recommendations include fast-tracking crucial tobacco control legislation, banning industry contributions, raising official awareness about interference, and promoting transparency in government-tobacco industry interactions.

This tussle is not just a local issue, but reflects a global challenge where health policies often collide with powerful industrial sectors. The tobacco industry’s influence is not new; historically, it has employed extensive lobbying and legal challenges to dilute health regulations. Yet, the cost of inaction is measured in lives lost and healthcare systems burdened by tobacco-related illnesses. 

Public health imperative

South Africa’s move to tighten tobacco control is not merely legislative; it’s a moral imperative to prioritise the health and well-being of its citizens over corporate profits, and a Constitutional duty of government to protect the health of the nation. The World Health Organisation (WHO) has long advocated for such measures, highlighting their effectiveness in reducing tobacco consumption and, consequently, lowering the incidence of diseases like cancer and heart disease. Passing the bill will reduce exposure, delay initiation by young people and bring South Africa’s domestic legislation closer to full implementation of the WHO Framework Convention on Tobacco Control (FCTC), a global standard. 

This Bill will contribute significantly to reducing heart diseases, cancer, diabetes and respiratory disease, reducing preventable harm, death and disability from noncommunicable diseases (NCDs) – an essential factor in the successful implementation of South Africa’s National Health Insurance (NHI). Tobacco is also a key risk factor for NCDs which now account for 51% of deaths in the country. Tobacco adds to the economic and healthcare burden, and these costs are subsidised by the taxpayer while the tobacco industry reaps the profit.

The Bill is about more than health. Tobacco-related premature deaths through NCDs and other tobacco-related diseases stifle South Africa’s economic development. Families lose income and suffer crippling healthcare costs. As tobacco use is currently estimated to cost South Africa R42 billion per year in tobacco-related illnesses, reducing these costs is essential. Estimates show that the economic cost due to productivity losses arising from absenteeism and early retirement due to ill health in South Africa, largely from NCDs, is expected to increase to 7.0% of GDP by 2030. The Tobacco Control Bill can make a vital contribution to curbing health-care costs and improving standards of living, with benefits only increasing over time.

Critics of the bill must recognise that the health benefits far outweigh the purported economic drawbacks. It’s time to reframe the narrative from one of economic loss to one of health gains, societal wellbeing, and long-term sustainability.

The Tobacco Control Bill represents a pivotal step forward in safeguarding public health and wellbeing.  As such, it is incumbent upon policymakers to pass the Bill, and for health advocates and the broader community to rally for swift action on this. Doing so will not only reaffirm the government’s commitment to public health but also set a precedent for addressing other health challenges with the same vigour and determination. In the end, the lasting legacy of robust public health policies will be a healthier, more resilient population, capable of contributing more fully to the nation’s growth and prosperity. – Health-e News

Author

Passing the Tobacco Control Bill would have substantial health benefits, reducing noncommunicable diseases and healthcare costs, and improving societal well-being.

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The threat of crime is a daily reality for community health workers, first appeared on Health-E News

By Palesa Matlala

Nomvula Nkabinde (56)  is a community health worker at Tladi TB Clinic in Tladi, Soweto. Everyday she and her colleagues traverse the streets of Naledi, Moletsane, Jabulani and Tladi. From as early as 7 am these community health workers walk door-to-door, visiting TB patients to ensure that they are adhering to treatment. 

While many of these workers are stationed in the communities they live in, their job isn’t without risk. 

On the 6th of April 2020 – at the height of the COVID-19 lockdown – Nkabinde and her colleague were visiting patients at Tladi Camp informal settlement. They were walking through a narrow passage when they were accosted by two men “who looked like they smoke nyaope” 

“We saw them when we were halfway through the passage. They walked towards us, one of them pulled out a knife under his blanket and they demanded our cellphones, money and bags,’’ she recalls.

Nkabinde says she felt confused and angry because of how quickly everything happened. And there was no other alternative exit point at the informal settlement, they had to use this route. 

Tladi informal settlement is a community of mostly Sotho-speaking people from Lesotho. It’s not uncommon to see men walking around the informal settlement dressed in traditional Ba-Sotho blankets. 

Being essential workers meant that Nkabinde and her colleagues had permits to move around during the hard lockdown imposed by the government. 

‘’During the lockdown, our workload increased because we had to trace TB patients in informal settlements, test them for the coronavirus and make sure that they don’t default on their medication,’’ says Nkabinde.

Who are community health workers

Community health workers are an essential part of primary health services. This group of health workers may not have formal qualifications such as a certificate or degree, they are trained in intervention. The scope of their work is wide and includes checking in on elderly and frail patients who are on chronic medication for diabetes and hypertension. And also pregnant women and mothers who have given birth in the past six to eight weeks. 

Their work is to deliver health services in the community, away from health facilities. Often they walk over 10kms per day, knocking on patients’ doors based on the cases they are assigned to by local clinics. 

Over the past decade South Africa has seen a lot of protest action by community health workers against the department health. Some of their grievances included being permanently employed by the department, salary increment and benefits, better working conditions and crime that they are faced with. 

Most community health workers are still underpaid, not absorbed by the Department of Health. Not much is said about the safety of community health workers, most of whom are women. 

‘’As a community health worker I am required to trace patients who default on their medication and check ups at the TB clinic. My partner and I are women who have to walk into homes where we are unsure what will happen to us,” Nkabinde tells Health-e News.

She says that the Community Policing Forum members only patrol the streets at night. During the day they are not there and this leaves community health workers at risk of being victims of crime. 

‘’When we go to our patients we say a little prayer first. When we get there we can’t ask to sit outside because patients must be treated in private rooms so that their rights are not violated. We need to go in the house. This compromises our safety because we enter into people’s homes without knowing what awaits us there.” 

It’s difficult to quantify the levels of crime committed against community health workers because the numbers are unavailable. 

Sibusiso Ndazala from the representative of the Public Servants Association says that most of their members, especially community health workers, have lost hope in them.

‘’Our members have been complaining about the dangerous and sorry working conditions that they find themselves in on a daily basis  – especially when going into informal settlements and high crime areas,” says Ndazala. 

 “As a union we are trying to assist them because we understand that they are not just workers but parents and breadwinners.”

He says the union has been working towards making sure that community health workers feel safe in their line of work. 

The trade union represents a total of 245,000 members in the public sectors across the country.

‘’People in our communities know that we see a lot of TB and HIV patients and we have become targets because they mix antiretroviral treatment with what they are smoking,’’ she adds.

In November of 2023 Nkabinde and her colleague were nearly mugged again. But this time, two community members of Tladi came to their rescue.

Nkabinde says that she has communicated her concerns with the clinic manager, but not much can be done because this is the scope of their work.  

Precarious working conditions 

Another community health worker from Springs clinic in Ekurhuleni says she’d had thoughts of resigning because of their working conditions. Getty Mahuma (33) works in the communities of Springs, Never Never informal settlements, Wright Park and Phola Park. 

Mahuma says going into any informal settlement is a risk because the shacks are built close together. This, she says, makes it easy for thieves to make a quick getaway and hide. 

‘’I love taking care of sick people, however, going into their homes and walking into informal settlements is my biggest fear. ’Imagine going into a place that you are not used to, where you don’t know anyone, at the same time looking for a person that you can’t identify and relying on the patient’s information given at the clinic.’’   

Mahuma and her colleague were mugged in 2019 in Wright Park just near Never Never informal settlement. They did not report the incident to the police.

‘’We went to trace a patient who defaulted on her TB treatment. We arrived at her house and found her with her friends. Three of them physically attacked us and took our belongings,” she recalls.

‘’Another time, it was around 8am on a Tuesday, when we went to Never Never informal settlement, three men came from a passage. They began approaching us and because the informal only has one entrance and exit point which was a bit far from where we were, we began running and screaming. People came out of their shacks and helped us. Those men could have raped us on that day,’’ says Mahuma.

As a way of protecting themselves, Mahuma says that they google search the addresses that are listed on patient records helping them to identify which places are high risk. She adds that some addresses are just open fields while others are spaza shops. 

‘’When we leave the clinic we know exactly where we are going and that prepares us mentally for danger that we may come across, she adds. 

Though she may want to resign from her work, she can’t because she has two children that she needs to provide for and South Africa is faced with an ongoing problem of unemployed healthcare workers. – Health-e News

Community health workers in South Africa face significant dangers while performing their duties in high-crime areas.

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Elections: how politics impacts women’s health, first appeared on Health-E News.

By Ina Skosana

Women’s health and well-being are influenced by a multitude of factors, ranging from access to healthcare to social, economic, and political determinants. The most pressing issue is often access to healthcare: is it safe and timely for all women? Equally important is the acceptability of these services — how women are treated within the healthcare sector, the respect and information they receive, and the education provided about common diseases and screenings.

Health-e News’ Ina Skosana spoke with Professor Salome Maswime, Head of the Global Surgery Division at the University of Cape Town, an obstetrician and gynaecologist, and advocate for women’s health rights, about how politics impact on women’s health and overall well-being. 

What are the major issues affecting women’s health and well-being?  

The most obvious issue that affects women’s health and well-being is access to healthcare. Is safe and timely access to health services available to all? 

Another factor that affects women’s health and well being is the acceptability of such services. This looks at how we treat women in the healthcare sector: are we as healthcare workers respectful, approachable, informative, do we educate them about common diseases and screening? 

The acceptability of the services that we provide depends largely on how we interact and engage with women, and the information that we give so that women are able to seek these services out timeously.  

Unfortunately we see a lot of delayed access to health services in South Africa.

These are women, for example, who may choose not to start antenatal care timeously, or women not screening for cervical cancer or breast cancer and presenting late. The ripple effect is that you end up with high mortality rates in this country from diseases that are preventable because of delays in accessing care.

What drives these delays in accessing care?

It has a lot  to do with how people view their healthcare system.
The high mortality rates for diseases that are preventable are a reflection of how accessible healthcare really is. It raises questions around how we’ve integrated healthcare into people’s normal and daily lives. 

For example, do women know that at the earliest that they fall pregnant or suspect that they’re pregnant, they need to start seeking antenatal care services.

Do women know at what age they need to go for their pap smears, or breast screening? Are we living in communities where these things are being discussed and women know where to go when they’ve got health concerns?

Do women trust the health system and that they will find the full range of quality health services wherever and whenever they need it.

These factors are known as social and economic determinants of health. 

What are the social and economic determinants of health? 

The socioeconomic determinants of health are factors that influence how people interact with the health system or access health services. These include issues like the education levels in particular communities. Research shows that people with a higher level of education live longer and are generally healthier than those with lower education levels. Employment is also a key determinant of health. The relationship between poverty and poor health is well-established.

All these factors are directly related to whether people are going to ultimately be able to seek and access healthcare.

If the country as a whole is not looking at addressing issues around employment, education, poverty and the wide inequality gap, then these will have a domino effect on the healthcare that people are able to access. More and more we are accepting and recognising that access to healthcare is dependent on socioeconomic factors and not just the availability of health services.

What are the political determinants of health? 

Political determinants of health refer to the health system. The state of the health system is determined by the resources, the infrastructure, and the investment in healthcare services that governments make. 

Political determinants also refer to the policies that are put in place that are either going to enable better healthcare or become a barrier. A simple example would be, at what age do we start screening women for cervical cancer? That’s a political decision. It’s not a clinical decision and in each country it is different, because such decisions are determined by the priorities set by each country, and the value that is placed on a woman and their health in their country.

So in countries where the health policies don’t favour women, you will find that women are not able to access healthcare, or are not able to access the highest quality of healthcare attainable because there are political barriers that stop them from receiving the healthcare that they should.

In South Africa, the national government is responsible for policy. Provinces are responsible for the healthcare services, and the local governments are often responsible for primary healthcare.

If you don’t have a functioning primary healthcare system then people, ultimately, are not able to access all of the care they’re supposed to get.

If clinics are not accessible, functional or efficient, then there will be a disconnect even between what is expected at policy level and what is available at primary healthcare level.

If you don’t invest in specialised and tertiary healthcare, the health system will have a high number of preventable deaths. An example would be a woman who has caesarean section complications, who needs to be admitted to an intensive care unit.

How does political leadership influence socioeconomic these drivers?

We know that health is dependent on so many other things. 

And so when you think about healthcare, you want to know that you are voting for a political party that understands primarily what the healthcare challenges are. A party that’s got a vision to improve access to healthcare. At the same time the party can’t be looking at  healthcare in isolation because of all the many other things that affect health.

And so the policies around education and other things should also speak to healthcare ultimately. And so you want to see that they are able to make those linkages and are not simply making promises.

Having a healthier society is also addressing other issues that lead to inequality that are ultimately going to improve or affect access to healthcare. – Health-e news.

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South Africa could face a critical diabetes drug stock-outs , first appeared on Health-E News.

By Yoliswa Sobuwa

Doctors are sounding the alarm over a predicted stock-out of insulin pen devices used by people living with diabetes. 

This comes after the pharmaceutical company Novo Nordisk, the previous supplier in South Africa, and other manufacturers failed to meet the demand to supply insulin pen devices. Instead, these manufacturers offer insulin in vials. Novo Nordisk has supplied over 14 million human insulin pens to South Africa over the last three years.

The difference between insulin pen sets and the vials is that the pens are already filled with the right dosage of insulin and they are easy to use. On the other hand with the vials, one has to measure the insulin dosage themselves. This increases the risk of an overdose. 

The medical non-profit organisation Doctors Without Borders (MSF) warns that transitioning from insulin pen devices to vials and syringes can have major consequences for patients. 

“People with diabetes who require insulin must calculate their food intake, check their sugar levels and predict how these will interact with the amount of insulin they administer, sometimes multiple times daily. The dosing mechanism on insulin pens provides a more straightforward way of measuring the correct dose, making it easier to inject outside the home,” MSF exp

Novo Nordisk has been the primary supplier of human insulin pens in previous tenders to the NDoH and has supplied over 14 million human insulin pens to South Africa over the last three years.

Diabetes is a noncommunicable disease that occurs when the pancreas does not produce enough insulin, or the body cannot effectively use the insulin it produces. About 4.2 million people in South Africa have the condition, and it’s the second leading cause of death. 

The doctors say changing medication could lead to serious complications such as extremely low blood glucose levels and loss of consciousness, and in some cases, even death.

Alarming circular 

Several weeks back, the National Department of Health issued a circular instructing healthcare workers to prioritise the available supply of insulin pen sets to the elderly, visually impaired individuals and young children. 

In the circular the department says a tender was awarded to Novo Nordisk in January this year aimed at securing a comprehensive range of insulin formulations. 

The department says bids were only received for specific insulin presentations which are vials of isophane insulin, soluble insulin, biphasic insulin and analogue insulin pen sets. 

“To address the shortfall of human insulin pen sets, a supplementary tender was advertised in March. The bid evaluation process of the supplementary tender is currently underway. In the meantime the department is obtaining quotations to address any supply constraints,” reads the circular. 

The department adds that there is a global shortage of human insulin pens as manufacturers are prioritising the products that are more profitable.

Dr Patrick Ngassa Piotie is a senior programme manager at the University of Pretoria’s Diabetes Research Centre and chairperson of the Diabetes Alliance. He warns that switching from pens to vials and syringes on short notice will impact patients with diabetes as well as the health department.  

“This is a devastating experience for people living with diabetes as it might bring complications to their lives. It will bring psychological problems for them as others will struggle to get the right dose when they are using the vials. This will also impact the way the health department will manage diabetes in the country. The government needs to get this under control,” he says.

He says the change of medication will also bring about psychological issues to patients as they will be stressing about when to take the next injection, something they are not used to.

“This will expose patients who have been used to human insulin pen devices since at least 2014  to complications as they might miss their dosage,” Piotie explains.   

Intricacies of diabetes treatment

Piote, who runs the Tshwane Insulin Project says it’s important to consider who benefits most from insulin pens. 

“They are mostly given to elderly patients and also kids so as to limit the number of injections they have to use to treat diabetes.”

According to MSF, people with diabetes may need to inject insulin up to four times a day. 

“Using insulin pens can simplify how insulin is administered, making dosing easier and reducing stigma when injections need to be given outside the home. Despite the advantages of the human insulin pen device over other injection methods, it remains inaccessible for most people with diabetes in low- and middle-income countries because it is expensive,” reads the statement.

MFS’s access campaign advocacy advisor, Candice Sehoma says South Africa is one of the countries that took the steps to make sure the human insulin pen devices are available in the public sector. 

“However, these pens are a bit more expensive. The low- and middle-income countries prefer to buy the most cost effective medication,” Sehoma says. 

MSF has called on Novo Nordisk and other manufacturers to acknowledge their responsibility and take immediate action to ensure a continuous supply of insulin pens to South Africa. A media enquiry was sent to Novo Nordisk last week and will be added as soon as received. – Health-e News 

Doctors Without Borders (MSF) warns that transitioning to vials at short notice could lead to serious health complications.

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South Africa bullied by Big Pharma in COVID-19 vaccines contract negotiations , first appeared on Health- E News.

By Yoliswa Sobuwa

More details of how South Africa was strong-armed into paying exorbitant prices for COVID-19 vaccines have emerged. This week the health advocacy organisation, Health Justice Initiative (HJI) released a follow-up analysis of the government’s negotiations with COVID-19 vaccine suppliers.  

“The South African government struggled to keep people healthy during the COVID-19 pandemic because it was bullied by big pharmaceutical companies demanding three times the prices of vaccines as compared to other countries,” says HJI director, Fatima Hassan. 

Last year HJI won a legal battle in the North Gauteng High Court in Pretoria. The court ordered the National  Department of Health to release all the COVID-19 procurement contracts and agreements. The government also had to disclose all negotiation records, minutes, correspondence, memoranda with companies that may have eventually signed an agreement, and those companies who didn’t end up signing agreements.  Until this judgement, the public had not been aware of the contents of the agreements or even the contracting parties. 

Hassan says HJI, with the support of many organisations around the world, has been  trying to get access to South Africa’s COVID-19 vaccine procurement contracts and negotiation reports over the last two and half years. She says these are the documents that the pharmaceutical companies did not want the South African public – or anybody – to see. 

HJI worked with Public Citizens, a US-based non-profit organisation, to analyse the tranche of documents. Their latest analysis shows that Moderna demanded extreme confidentiality provisions around any discussions of supply. Pfizer completely barred South Africa from disclosing any information discussed during negotiations, including prices. 

“And it is really clear why they wanted to do that, we now have unprecedented insight into their aims and their tactics which reveal a profit maximising strategy,” Hassan says. 

Strong-armed negotiations

Hassan believes that pharmaceutical companies wanted to shield themselves from the responsibility of any problems associated with deliveries or vaccine supplies, putting the burden of even importing vaccines on the South African government. 

“South Africa government was for the better part of 2020 and 2021 heavily criticised for not engaging with Moderna. We now know from the documents revealed to us that the negotiations with Moderna actually commenced in December 2020. 

“However, those negotiations and discussions were taking place subject to a confidentiality agreement. In other words Moderna made it basically legally impossible for the South African government to share with the public that it was even in negotiations with them for mRNA vaccines,” she says. 

Their analysis shows that Moderna was actually the company that took the most aggressive approach to shield any of its vaccine supplies from public accountability. 

“Moderna demanded an excessive price when compared to other countries. It also insisted on the right to override contractual arbitration proceedings. I think this explains why South Africa did not, in the end, receive a single supply of a vaccine from Moderna,” Hassan says. 

Jishan Ravinthiran, a researcher at Public Citizen adds that South African officials tried to secure more agreements but could not overcome the concentrated private power of the pharmaceutical companies that controlled the global vaccine supply. 

“With Moderna we got two documents: a confidentiality agreement that was about entering a potential vaccine supply transaction and a summary framework about the principle terms of the proposed transaction. We also have several drafts of Pfizer procurement agreements. These include revisions from South African officials and commentary that showed their real time reactions to Pfizer’s proposed contractual terms,” he says. 

He adds that they find a disturbing picture of how corporations can exploit public health emergencies to serve their own interest to the detriment of the health and safety of an entire nation. 

“South Africa gave up millions of dollars to secure vaccine doses that had no certainty of reaching its residents in a timely manner. Government officials tried to include revisions that would have allowed for oversight by lawmakers and executive officials but none were included in the final agreement,” he says.

He says Pfizer obtained iron clad confidentiality protections to safeguard its profits in the future and refused any and all flexibilities for public health which is unacceptable. 

“So what becomes clear after reviewing these documents is that concentrated private power in public health emergencies allows pharmaceutical companies to seek and impose unjust terms on other nations. The consequences of their profit maximising motive are felt most harshly by those in low- and middle-income countries,” he says. 

Ravinthiran says if these abuses are not addressed, it will be a risk that will allow them to continue in the future.  

Government’s hands were tied

Meanwhile, Dr Matthew Kavanagh the director of the Center for Global Health Policy and Politics at Georgetown University in the US adds that the government tried to address its international obligations and its obligations to its people. 

“South Africa is the wealthiest country on the African continent. But it was unable to secure even the most basic provisions that would apply to contracting, good procurement, transparency and equitable access.”  

He says it was the provisions of the contracts with the pharmaceutical companies that prevented South Africa from securing the basic things needed to run a good public health response in the middle of a pandemic. 

“These documents illustrate the failure of global cooperation during COVID-19. `As a result, low- and middle-income countries are going to have to be ready to exercise compulsory licensing and other flexibilities that are built into the international trade law system, if they are going to be able to respond to pandemics and be able to bring down prices of drugs,” he says. 

Peter Maybarduk ,access to medicine director at Public Citizen, praised the work done by HJI to develop historical records not just for South Africa but for the world.  

“We have seen similar lessons out of Columbia, Brazil and other countries where contracts or fragments of contracts have come to light over the years and have been analysed. We see a similar pattern everywhere of extraordinary deference to drug makers during historic crises. We will have to do better in the future,” he says. –

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Free State doctor survives shooting, robbery at hospital living quarters , first appeared on Health-E News.

By Molefi Sompane

Medical staff at Manapo Hospital in Phuthaditjhaba in the Free State have called on the health department to increase security in and around the hospital. This comes after a newly hired doctor was shot and wounded inside the doctors’ living quarters during a robbery. 

Dr Tshabi Seeta, who previously survived a separate robbery, says security at the hospital needs beefing up. “We have been asking the hospital to hire more security officers. Each time something happens they claim to notify the province to put more officers but nothing happens,” he says. 

Seeta says patients are also not safe in the facility. 

“In 2022 a man came in with stab wounds, and he was further stabbed inside the ward. He was transferred to Bethlehem for his safety. Today a doctor survives death, this will cause many of us to want to relocate to other, safer hospitals,” Seeta says.

Free State MEC for Health, Mathabo Leeto says she is reeling with shock after “the unpleasant news of shooting of a 26 year old male doctor at Mofumahadi Manapo Mopeli Regional Hospital in QwaQwa on the evening of Tuesday, 21 May 2024 at about 8pm.”

Despite reports of unsafe living quarters within the hospital the MEC says that the area is secured.

“This is an unexpected violent burglary incident at the secured doctors’ quarters at the hospital precinct by unknown assailants, a doctor fell victim of this near fatal shooting,” says Leeto.

She says the doctor was rushed into theatre. None of his vital organs were affected. He is now recovering in the ICU. 

“The incident will be thoroughly investigated, so that we can take further steps to tighten security in our health facilit

Similar incidents in the country include the rape of a doctor at PeIonomi Tertiary Hospital in Mangaung in 2019, and the robbery of a doctor at Elizabeth Ross Hospital in Qwaqwa in 2022.

Police confirmed the incident at Manapo hospital. Warrant Officer Mmako Mophiring says they haven’t taken a statement from the victim.

“We were called to the Manapo Hospital last night, Tuesday 21 May, and we found an African male doctor already taken to theatre. We were told he was shot by an unknown person. We will take his statement once he is able to cooperate after he is discharged,” Mophiring says.

Tseko Mokoa, a patient at the hospital, says it is also not safe for them as patients.

“You’ll find people just loitering in the corridors of the hospital, even after visiting hours. It is easy to enter the hospital gates. Security officers don’t search people at the gate,” he says. – Health-e News 

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Patients at Free State clinics say doctors only visit once a year, first appeared on Health- E News.

By Molefi Sompane

Patients using public clinics in Botshabelo in the Free State say they haven’t seen a doctor at their regular facilities in months. 

Sbahle Bunu, 73, a diabetic patient tells Health-e News having no doctors at Potlako Motlohi clinic makes her and others feel deserted. The government, she says, should appoint full-time doctors at public clinics. 

“We are suffering, how can I go for a year without seeing a doctor? It has been mere talk from those in power, promising to bring us a doctor to our clinic. But it’s been years, and we still only see a doctor once a year,” she says.

Health-e News has seen a list from Potlako Motlohi clinic where Bunu is number 142 on a list of 194 patients waiting to see a doctor.  She doesn’t have an indication of the date, but in the meantime, she’s being seen by a nurse at the clinic for her routine check ups. 

Moeketsi Makate, 47, is an asthma patient at Pule Sefatsa clinic. He was recently examined by a doctor but is worried about the next opportunity to see one. 

“It’s like we are being deprived of our rights to health. It takes a year before one can be able to see a doctor,” says Makate.

But provincial health spokesperson, Mondli Mvambi says the department has doctors who visit these clinics regularly.  

“All 13 clinics in Botshabelo have doctors who visit the clinics two to three times a week. We have four NHI sessional doctors who visited 10 clinics.  The other three facilities are visited by doctors from Botshabelo hospital,” says Mvambi. 

He adds that the department frequently announces when a doctor will visit a particular clinic and patients from nearby communities are informed by the clinic managers so they fill the lists.

“Managers inform patients and they draft a list so as to find out who and what kind of patient there is to see a doctor. I understand that some clinics, due to having more people, require special days for a doctor to arrange to come to that clinic,” Mvambi says.  

Unemployed doctors

Last year MEC of Health Mathabo Leeto, in her maiden budget vote speech, promised to  “deploy all Cuban and South African trained doctors to clinics and community health centres on a full time basis”.  But this has not happened. 

Thando Molelekoa, 35, graduated from Cuban Medical University in 2022 but is unemployed. She is one of the over 800 healthcare professionals who took to the streets earlier this year calling on the national health department to employ them. 

She says she is willing to work at facilities in rural areas. In March, Molelekoa wrote the board exam that the Health Professional Council of South Africa  requires of foreign-trained doctors. 

“In response to our protests the Minister of Health, Dr Joe Phaahla, promised that there would be funding in the national budget. But his claims proved to be baseless. Vacancy rates remain high, while also overtime pay for medical personnel faces drastic cuts. While our healthcare system is already on its knees, there will be further staff shortages, particularly during night shifts, weekends, and public holidays – when casualties tend to increase.

“Clinics in Cuba have doctors for daily consultations, something that is not happening daily in South Africa, especially in the rural areas. I was trained to work in rural areas but I’m not working,” she adds,

Advocacy group, Treatment Action Campaign’s Kebotsang Shuping says the government should prioritise primary healthcare services by making doctors available. 

“The way our people in Mangaung and the entire province are being treated is uncalled for.  It cannot be acceptable that a doctor only comes to a clinic once a year while doctors are needed,” she says.

Early this year the Department of Health in the Free State appointed 61 doctors in an effort to stabilise the overburdened system. 

During the State of the Province Address, Free State Premier Mxolisi Dukwana announced that a total of 217 medical interns and community service professionals, including dieticians, radiographers, audiologists and physiotherapists, were employed.

Despite these highly publicised appointments the province seems to still be facing a conundrum of clinics without permanent doctors, while medical professionals sit without employment. – Health-e News

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Unemployed doctors in Mpumalanga sitting at home while ‘there are clinics without doctors’, first appeared on Health-E News.

By Yoliswa Sobuwa

Twenty-nine-year-old Dieketseng*, a junior doctor from Bushbuckridge in Mpumalanga, is the first person in her family to go to university. But, her dream of working as a doctor and providing for her family is yet to materialise.  

Dieketseng finished her obligated community service in December and has been sitting at home since, unable to find a job. Now she, along with four siblings and her two-year-old daughter, depend on the pension her mother gets from the government. 

She is only one of nearly 80 junior doctors in Mpumalanga who have been looking for work since December. 

“I was one of the few people who obtained a bursary to study in Cuba with the agreement to work in the province after completing my studies. This was something big for my family as it meant I would be able to take care of them financially,” Dieketseng says. 

Broken promises 

Dieketseng and several of her fellow unemployed doctors spoke with Health-e News on conditions of anonymity as they fear reprisal. The junior doctors say Mpumalanga Health’s Head of Department told them, in the last week of March, that they would be employed in the first week of April. 

“When I completed [my studies] in December I had hopes of growing in the medical field. I immediately applied as the department said we should, but nothing, the department is silent. In March we reached out to the department and we were told we would be employed by the 1st week of April,” says Dieketseng.

On 2 April Jabulani Nkosi, the provincial department’s Chief Director of Human Resources wrote a letter to the chief directors, corporate services, hospital CEOs and clinical managers about the appointment of medical officers. The letter includes details of 77 unemployed junior doctors, and reads:  

“Please receive attached hereto a list of unemployed medical officers who should be prioritised in the advertised posts. A management plan should be submitted to the office of the Chief Director Human Resource management and challenges communicated. The due date for the finalisation of the hiring process is 30 April 2024.” 

Dieketseng and her colleagues are still unemployed. 

“We are now in May and the

Another unemployed doctor from Katjibane village in Nkangala District says it doesn’t make sense that the province gave them bursaries to study then not employ them. He says, of the group of 77 unemployed doctors, 14 studied in Cuba. The rest are bursary holders who studied at South African universities.

“Unemployment has affected me so badly. My family is struggling financially. I was the only one working at home since 2021 [during his internship and community service), and I now stand to lose my car.”  

He tries to temporarily locum (fill in) for other doctors to make ends meet. “This doesn’t help because sometimes you can go a week or two without being called.”  

We spoke with another doctor from Bushbuckridge who also studied in Cuba courtesy of the provincial government.  

“There are clinics without doctors and hospitals where doctors have to attend to emergency room and theatre operations causing long queues, something that affects the quality of healthcare. But we are sitting at home with our medical degrees, doing nothing,” says the 32-year-old.  

She says even though the bursary contract states that they are obligated to work for the Mpumalanga health department, she has decided to apply in other provinces. 

“If I get a job I will deal with legal implications later. For now I need to work and be able to keep the wolf at bay. My family cannot survive on empty promises,” she says. 

National problem

Early in February a group of unemployed doctors from all over the country marched to Union Buildings in Pretoria asking President Cyril Ramaphosa to intervene in their plight for jobs. 

During the same month, Health Minister Dr Joe Phaahla announced that the government was working tirelessly to ensure that 800 unemployed doctors who want to join the public service are placed by 1 April. 

In the first week of April a group of about 100 unemployed junior doctors camped out in front of the KwaZulu-Natal health department’s offices in Pietermaritzburg. 

And most recently, unemployed doctors in the Eastern Cape have threatened a sit-in at the provincial health office if they aren’t employed.  

In April Health-e News spoke with Dr Nkateko Mnisi deputy president of the South African Medical Association Trade Union who said the unemployment of junior doctors has become an annual issue. 

“Last year we handed a memorandum about unemployed doctors to Health Minister Dr Joe Phaahla. Early this year we were in the same situation… Meanwhile public hospitals are operating on skeleton staff.” 

A media enquiry was sent to the Mpumalanga health department and will be added as soon as it has been received. – Health-e News

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